Researchers will look at functional outcomes, activity level, health-related quality of life, graft survivorship, knee stability, knee motion, and growth disturbance. Rather than developing new techniques, this study aims to determine the safety and effectiveness of established procedures. The study, which began in 2016, will compare the outcomes of four surgical procedures as well as non-surgical treatment to measure the safety and effectiveness of each strategy. The PLUTO study (Pediatric ACL: Understanding Treatment Outcomes) is following pediatric patients who have undergone treatment for torn ACLs in order to evaluate the outcomes and effectiveness of various surgical and non-surgical treatments. To close this gap in knowledge, physician researchers at Boston Children’s and nine other centers are conducting a 10-year, multi-site study of ACL treatment strategies. However, they lack information about the long-term effectiveness and safety of these approaches. Thanks to the innovations of the past several decades, physicians now have several surgical and non-surgical options for treating patients with torn ACLs. Micheli and Mininder Kocher, MD, MPH, chief of the Sports Medicine Division, have documented the success of this surgery and other procedures developed to reduce the risk of growth plate injury in children and adolescents. This operation is now also used in growing children with ACL tears with excellent long-term success and no growth disturbances. He avoided the growth plate by transferring the patient’s iliotibial band (the ligament running from the hip to the shin) around and into the knee. In 1979, Lyle Micheli, MD, developed a surgical procedure to replace the ACL of a toddler born without the ligament. This extended wait limited children’s participation in sports and put them at risk of further injury. Instead, surgeons routinely counseled patients and families to wait until after the child was past puberty to repair a torn ACL. Reconstruction surgery required the surgeon to drill tunnels through the child’s growth plate, which could disrupt their future growth. In the past, orthopedic surgeons and sports medicine physicians only rarely recommended surgery for children and young teens with torn ACLs. Pioneers in ACL surgery for growing bodies Specialists in ACL care and recovery at Boston Children’s Hospital are leading the way in all aspects of ACL research: from less invasive surgical techniques that reduce the risk of arthritis to psychological considerations, injury prevention, and return-to-play protocols. Martha Murray and Lyle Micheli look at imaging of a patient's knee.
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